PURPOSE: Over twenty years have now passed since idiopathic acute eosinophilic pneumonia (IAEP) was first described. Unfortunately the rarity and difficulty recognizing the disease have limited new findings. The goal of this study was to further expand the knowledge of the disease through a more robust case series.
METHODS: Epidemiologic data was extracted by chart review of all cases given the diagnosis of IAEP in deployed active duty soldiers. These cases were identified both retrospectively and prospectively and placed in a database for review from March of 2003 to March of 2010. Our own proposed diagnostic criteria were used to confirm the diagnosis which excluded a number of patients in the original article by Shorr et al that did not have BAL data.
RESULTS: There were 44 cases cases of IAEP diagnosed in deployed active duty soldiers. Fever and pulmonary infiltrates were essentially universal. Eosinophilic alveolitis was more various than previous case series and no deaths occurred. Multiorgan dysfunction and shock was also exceedingly rare. As in other case series smoking and variations in smoking habits were common.
CONCLUSIONS: IAEP is a smoking associated disease that has been infrequently recognized in our deployed active duty population. We have shown that the eosinophilic alveolitis is extremely variable and may not be directly related to disease severity.
CLINICAL IMPLICATIONS: Our experience demonstrates the rapid effectiveness of intravenous corticosteroids, and we propose a specific steroid treatment algorithm. We found that consideration of IAEP and early bronchoscopy have important diagnostic and therapeutic implications. We also propose modified diagnostic criteria, which may enhance early access to a successful treatment and help prevent possible respiratory failure.
DISCLOSURE: The following authors have nothing to disclose: Christy Sine, Patrick Allan, Ralph Haynes, Stephanie Scoville, Eric Shuping, Anna Hultman, Erik Osborn
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